Patients of federally funded health centers use health system less

April 28, 2014

People who rely on the 9,000 federally funded health centers in the U.S. utilize the health care system less than patients who get their primary care from other channels, according to a study published April 28 in the journal Health Services Research.

The two-year study, involving more than 33,000 adults, found that these patients had fewer office visits, fewer hospitalizations and were more likely to get some preventative care measures.

"Health centers add value to the health care system by providing socially and medically disadvantaged patients with care that results in lower utilization and maintained or improved preventative care," wrote the study's authors, many of whom were University of Chicago faculty.

The report is an important step in the ongoing study of health care costs and benefits, as the entire sector undergoes massive changes, and questions abound over the sustainability of the current system.

Aside from fewer office and emergency room visits, health center patients, as a group, received these preventative care measures at a similar rate -- or even more frequently -- than patients of other clinics:

Breast cancer screening

Cervical cancer screening

Diet advice

Exercise advice

Hypertension screening

Cholesterol checks

Health centers provide comprehensive primary care to patients, regardless of their ability to pay. By law, they are located in medically underserved areas with insufficient primary care providers, high infant mortality, high poverty and/or large elderly populations.

Corresponding author Neda Laiteerapong, MD, assistant professor of medicine at University of Chicago Medicine, said her research found that these centers serve patient populations that are generally outside the regular health care system. Patients are often immigrants, working poor, and people who do not have a lot of socio-economic resources and may be unaware of how to advocate for themselves.

"The centers are an important part of the fabric of the health care system," she said.

Health centers funded by Section 330 of the Public Health Service Act cared for 21.1 million people in 2012, 36 percent of whom were uninsured and 94 percent lived below 200 percent of the federal poverty line.

Also in 2012, health center sites had almost 85 million patient visits and employed 148,000 people, including physicians, nurse practitioners, physician assistants and certified nurse midwives.

Laiteerapong's study examined adults, aged 18 years or older, who had at least one clinic visit - either to a federally funded health center or other care - and who lived within 20 miles of a health center. Essentially, these were people who were users of the health care system, had the choice of more than one type of provider, and who were within a reasonable distance to a provider.

"The number of patients cared for at [federally funded health centers] is expected to grow considerably due to increases in program funding and the expansion of the insured population, resulting from implementation of the Affordable Care Act," said the report.

Given that expectation, gaining a better understanding of these centers and their outcomes was a key driving factor behind the study, said Laiteerapong.

Previous studies on health care utilization and Section 330 health centers had produced mixed results, creating some uncertainty about the effects this safety net program had on health care.

Unlike earlier reports, Laiteerapong and her associates utilized limited access data from the Medical Expenditure Panel Survey (MEPS), collected by the Agency for Healthcare Research and Quality, and the Bureau of Primary Health Care giving the researchers the ability to match patients by address to nearby health centers.

Furthermore, the study used more sophisticated adjustments, specifically propensity score methods, to account for as many variables as possible that could distort the results or create misleading or irrelevant outcomes.

"The federally funded health center system is a valuable part of the health care system for the safety-net populations," Laiteerapong said.

She anticipates such centers will continue to play an important role in the health care system.

"I hope this research helps give health centers and the programs that fund them, more power to say 'we're effective, we're helping people and we're not costing a lot of extra tax dollars, and we're probably saving money'," she said.